Physician Focus: HIV/AIDS, then and now

Friday

Mar 28, 2014 at 12:27 PMMar 28, 2014 at 12:27 PM

By Dr. Thomas TreadwellMore Content Now

On July 3, 1981, the U.S. Centers for Disease Control and Prevention issued what may be the most stunning report in its history. The CDC’s Morbidity and Mortality Weekly Report on that date reported an outbreak of 26 deaths in previously healthy gay men who were developing strange tumors and a very unusual lung infection.It was the first official account of what was later to be identified as HIV, or human immunodeficiency virus, the virus that leads to AIDS. The deaths were the first of millions more to come.Since that time, HIV and AIDS have claimed the lives of 30 million people worldwide. And while the virus is today a manageable disease, HIV and AIDS remain major causes of illness and death.More than 1 million people in the U.S. now live with HIV, and about 16 percent of those do not know they are infected. Some 50,000 new HIV infections occur each year, and 15,000 people die each year from AIDS in the U.S. About 2.5 million new cases of the HIV virus occur each year, with a particularly large burden of infection in SubSaharan Africa and Southern Asia.As a physician specializing in infectious diseases who treated his first AIDS patients just days after the CDC report, I vividly recall the early days of the disease. They were a truly horrible time. We didn’t know what was causing the disease, and no treatment existed. Whatever was causing it was destroying the immune system, and it was killing people quickly. Most patients died within weeks or months of the diagnosis.Progress against the disease came slowly. In 1985, scientists developed a blood test that could test people for HIV. This was an important step forward for two reasons: first, we could find out who was infected, and second, the test allowed us to protect the blood supply, as HIV cases from transfusions were a huge problem in the early 1980s. More progress came in 1986, with the development of the drug AZT, but deaths still increased.A breakthrough came in 1990 when scientists figured out the dynamics of the infection. That led to the creation of an AIDS “cocktail” in the mid-1990s, a triple therapy with more than one drug that for the first time led to a decline in deaths. Although the “cocktail” was a significant advance, the medications had multiple side effects, and patients were taking a complicated regimen of up to 20 pills a day.Throughout the next decade, medical advances continued, and today, more than 20 drugs exist to treat HIV. Most patients now take just one pill once a day for treatment.While research continues into vaccines and cures, HIV and AIDS remain primary targets of public health officials. Today’s guidelines recommend that everyone between the ages of 13 and 65 get tested with a single HIV test, with those in high-risk groups (gay and bisexual men, substance abusers) being tested more often. Pregnant women have been tested for some time and that has had a significant effect on reducing neonatal transmission, as the fetus can be protected even if the mother is infected — provided doctors know the mother is infected.Though HIV still is not curable, medical science has turned a disease that once guaranteed death into a manageable condition. The life expectancy of a newly-infected patient today is near normal — a remarkable turnaround from the early days of the epidemic.As a physician who has treated HIV patients since the virus first appeared and who continues to do so, I cannot overemphasize the importance of testing. Physicians can’t treat a patient if he or she doesn’t know about the infection. With hundreds of thousands of people now living with HIV in the U.S. unaware they have the HIV virus, the risk remains that those patients might spread the disease to others. Testing for HIV should today be regarded as a personal and public health necessity.For more information on HIV and AIDs, including prevention efforts, risk factors, and how the virus is spread, visit cdc.gov/hiv. For a video discussion, visit physicianfocus.org/hivandaids.Thomas Treadwell, M.D., is director of the Infectious Disease Clinic at MetroWest Medical Center in Framingham. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.